Nonsurgical retrieval of embolized coronary stents

Embolization of coronary stents before deployment is a rare but challenging complication of coronary stenting. Different methods for nonsurgical stent retrieval have been suggested. There were 20 cases (0.90%) of intracoronar y stent embolization among 2,211 patients who underwent implantation of 4,0 66 stents. Twelve of 1,147 manually crimped stents (1.04%) and eight of 2,9 19 premounted stents were lost (0.27%, P < 0.01) during retraction of the d elivery system, because the target lesion could not be either reached or cr ossed. Percutaneous retrieval was successfully carried out in 10 of 14 pati ents (71%) in whom retrieval was attempted. In 10 patients, stent retrieval was tried with 1.5-mm low-profile angioplasty balloon catheters (success i n 7/10) and in seven cases with myocardial biopsy forceps or a gooseneck sn are (success in 3/7). Three patients (15%) underwent urgent coronary artery bypass surgery after failed percutaneous retrieval, but their outcomes wer e fatal. In two patients, stents were compressed against the vessel wall by another stent, without compromising coronary blood flow. In two patients, a stent was lost to the periphery without clinical side effects; treatment was conservative in these cases. Embolization of stents before deployment i s a rare but serious complication of coronary stenting, with hazardous pote ntial for the patient. Manual mounting of stents is associated with a signi ficantly higher risk of stent embolization. Stent retrieval from the corona ry circulation with low-profile angioplasty balloon catheters is a readily available and technically familiar approach that has a relatively high succ ess rate. Cathet Cardiovasc. Intervent 51:432-440, 2000. (C) 2000 Wiley-Lis s, Inc.